Computed tomographic diagnosis of a common bile duct abscess and secondary extrahepatic biliary duct obstruction in a potbelly pig.

A potbelly pig was evaluated for anorexia and icterus. Clinicopathologic abnormalities suggested an active inflammatory hepatobiliary process. Ultrasound and CT of the abdomen revealed an extrahepatic biliary obstruction of the common bile duct (CBD). Surgical exploration and choledochotomy revealed a markedly dilated CBD containing a large volume of intraluminal inspissated biliary material. This case report describes the imaging findings of an extrahepatic biliary obstruction secondary to abscessation within the CBD in a pig.

A Cathepsin-Targeted Quenched Activity-Based Probe Facilitates Enhanced Detection of Human Tumors during Resection.

PURPOSE: Fluorescence-guided surgery using tumor-targeted contrast agents has been developed to improve the completeness of oncologic resections. Quenched activity-based probes that fluoresce after covalently binding to tumor-specific enzymes have been proposed to improve specificity, but none have been tested in humans. Here, we report the successful clinical translation of a cathepsin activity-based probe (VGT-309) for fluorescence-guided surgery. EXPERIMENTAL DESIGN: We optimized the specificity, dosing, and timing of VGT-309 in preclinical models of lung cancer. To evaluate clinical feasibility, we conducted a canine study of VGT-309 during pulmonary tumor resection. We then conducted a randomized, double-blind, dose-escalation study in healthy human volunteers receiving VGT-309 to evaluate safety. Finally, we tested VGT-309 in humans undergoing lung cancer surgery. RESULTS: In preclinical models, we found highly specific tumor cell labeling that was blocked by a broad spectrum cathepsin inhibitor. When evaluating VGT-309 for guidance during resection of canine tumors, we found that the probe selectively labeled tumors and demonstrated high tumor-to-background ratio (TBR; range: 2.15-3.71). In the Phase I human study, we found that VGT-309 was safe at all doses studied. In the ongoing Phase II trial, we report two cases in which VGT-309 localized visually occult, non-palpable tumors (TBRs = 2.83 and 7.18) in real time to illustrate its successful clinical translation and potential to improve surgical management. CONCLUSIONS: This first-in-human study demonstrates the safety and feasibility of VGT-309 to label human pulmonary tumors during resection. These results may be generalizable to other cancers due to cathepsin overexpression in many solid tumors.

Cystoscopic Abnormalities in Dogs Presented for Episioplasty.

A recessed vulva is a conformational abnormality that predisposes affected dogs to urinary tract infections. An episioplasty can be recommended for correction of this abnormality when medical management of recurrent urinary tract infection fails. The objective of this study was to investigate the type and incidence of urogenital abnormalities visualized by cystoscopy in dogs presenting for episioplasty. Medical records of 29 dogs that presented for an episioplasty and had a concurrent or prior cystoscopy were reviewed. Eleven of the 29 dogs had urogenital abnormalities diagnosed on cystoscopic evaluation, and 1 dog was diagnosed with a urogenital abnormality during vaginal examination while under general anesthesia. Ten of the dogs with urogenital abnormalities had a corrective procedure performed, 8 of which were cystoscopically assisted. Cystoscopy provides the ability to directly visualize the urinary tract and obtain samples for biopsy and culture and facilitates correction of some anatomic abnormalities that may predispose the patient to developing recurrent urinary tract infections. Cystoscopy should be considered as a routine part of a thorough evaluation of the urinary tract in cases presenting for episioplasty.

Severity of nasopharyngeal collapse before and after corrective upper airway surgery in brachycephalic dogs.

OBJECTIVE: To determine the severity of nasopharyngeal collapse in brachycephalic dogs before and after corrective airway surgery. ANIMALS: Twenty-three brachycephalic dogs (21 with clinical signs referrable to the upper airway) and nine clinically normal nonbrachycephalic dogs (controls). METHODS: Dogs were evaluated with fluoroscopy awake and standing with the head in a neutral position. The magnitude of nasopharyngeal collapse was measured as the maximum reduction in the dorsoventral dimension of the nasopharynx during respiration and expressed as a percentage. Brachycephalic dogs were anesthetized, the airway evaluated, and corrective upper airway surgery (alaplasty, staphylectomy, sacculectomy, tonsillectomy) was performed. A cohort (n = 11) of the surgically treated brachycephalic dogs had fluoroscopy repeated a minimum of 6 weeks after surgery. RESULTS: Median preoperative reduction in the dorsoventral dimensions of the nasopharynx was greater in brachycephalic dogs (65%; range: 8-100%) than in controls (10%; range: 1-24%, p = .0001). Surgery did not improve the reduction in dorsoventral diameter of the nasopharynx during respiration in brachycephalic dogs (n = 11) postoperatively (p = .0505). CONCLUSION AND CLINICAL SIGNIFICANCE: Nasopharyngeal collapse was a common and sometimes severe component of brachycephalic airway obstruction syndrome in the cohort of dogs evaluated. The lack of significant postoperative improvement may represent a type II error, a failure to adequately address anatomical abnormalities that increase resistance to airflow, or inadequate upper airway dilator muscle function in some brachycephalic dogs.

Dogs ≥ five years of age at the time of congenital extrahepatic portosystemic shunt diagnosis have better long-term outcomes with surgical attenuation than with medical management alone.

OBJECTIVE: To determine the outcome in dogs diagnosed with congenital extrahepatic portosystemic shunts (EHPSS) at ≥ 5 years of age treated with medical management only (M) or with surgical attenuation (S). The hypothesis was that dogs undergoing surgical attenuation would have a longer survival time than dogs undergoing medical management only. ANIMALS: 351 dogs definitively diagnosed with EHPSS at ≥ 5 years of age. PROCEDURES: Medical records from 2009 to 2019 at 16 veterinary teaching hospitals were evaluated. Data collected included signalment, clinical signs at diagnosis, clinicopathologic data, surgical and medical treatments, shunt morphology, clinical signs and medical treatments at 6 to 12 months after diagnosis, and survival time. RESULTS: 351 dogs (M, 119 [33.9%]; S, 232 [66.1%]) were included in the study. Survival time was longer with surgery than medical management (hazard ratio, 4.2; M, 3.4 years; S, 10.9 years). Continued clinical signs at 6 to 12 months after diagnosis were more common with medical management (M, 40% [33/88]; S, 14% [21/155]). Continued medical treatments at 6 to 12 months after diagnosis were more common in the medical management group (M, 78% [69/88]; S, 34% [53/155]). Perioperative mortality rate was 7.3%. CLINICAL RELEVANCE: Dogs diagnosed at ≥ 5 years of age with EHPSS have significantly better survival times and fewer clinical signs with surgical attenuation, compared with medical management. Older dogs have similar surgical mortality rates to dogs of all ages after surgical EHPSS attenuation.

Surgical treatment of a double aortic arch in a dog.

An 8-month-old spayed female Labrador retriever dog was evaluated for regurgitation 6 months after surgery for a suspected vascular ring anomaly. The dog had a history of regurgitation and slow development as a puppy. An initial left-sided exploratory thoracotomy was unsuccessful in identifying and treating a vascular ring anomaly. The dog was subsequently presented to the PennVet Emergency Service for regurgitation. Thoracic radiography showed cranial thoracic esophageal dilation and an esophageal foreign body that was then removed endoscopically. Subsequent computed tomographic (CT) angiography revealed a double aortic arch. A left 4th intercostal space thoracotomy was performed. The smaller left aortic arch and a left ligamentum arteriosum were ligated and transected. The dog recovered uneventfully and was healthy at the 1-month follow-up visit. This is the 5th reported successful surgical correction of a double aortic arch in a dog. Computed tomographic angiography was essential in diagnosis and surgical planning. Key clinical message: Although uncommon, double aortic arches can occur and present a diagnostic and surgical challenge when a persistent right aortic arch is suspected. Computed tomographic angiography provides an accurate preoperative diagnosis and allows for surgical planning.

Traitement chirurgical d'un double arc aortique chez un chien. Une chienne Labrador retriever femelle stérilisée âgée de 8 mois a été évaluée pour régurgitation 6 mois après une chirurgie pour une anomalie suspectée de l'anneau vasculaire. Le chien avait des antécédents de régurgitation et de développement lent en tant que chiot. Une première thoracotomie exploratrice gauche n'a pas permis d'identifier et de traiter une anomalie de l'anneau vasculaire. Le chien a ensuite été présenté au service d'urgence PennVet pour régurgitation. La radiographie thoracique a montré une dilatation de l'oesophage thoracique crânien et un corps étranger oesophagien qui a ensuite été retiré par endoscopie. L'angiographie tomodensitométrique (TDM) subséquente a révélé un double arc aortique. Une thoracotomie du 4e espace intercostal gauche a été réalisée. Le plus petit arc aortique gauche et un ligament artériel gauche ont été ligaturés et sectionnés. Le chien s'est rétabli sans incident et était en bonne santé lors de la visite de suivi à 1 mois. Il s'agit de la cinquième correction chirurgicale réussie d'un double arc aortique chez un chien. L'angiographie tomodensitométrique était essentielle dans le diagnostic et la planification chirurgicale.Message clinique clé :Bien que rares, des arcs aortiques doubles peuvent survenir et présenter un défi diagnostique et chirurgical lorsqu'un arc aortique droit persistant est suspecté. L'angiographie tomodensitométrique fournit un diagnostic préopératoire précis et permet une planification chirurgicale.(Traduit par Dr Serge Messier).

Gorilla Glue Ingestion in Dogs: 22 Cases (2005-2019).

Gorilla Glue contains methylene diphenyl diisocyanate that expands significantly and hardens once exposed to moisture. Case reports of methylene diphenyl diisocyanate glue ingestion in dogs document gastrointestinal foreign body formation and mechanical obstruction. Medical record queries from four veterinary hospitals identified 22 dogs with Gorilla Glue ingestion. Records were evaluated retrospectively to characterize clinical presentation, diagnostic findings, treatment, and patient outcome. Vomiting was the most common clinical sign (n = 11), with a median time from ingestion to presentation of 42 hr. Abnormal abdominal palpation (e.g., pain) was the most reported examination finding (n = 13). Radiographs were performed in 18/22 dogs, with Gorilla Glue expansion described as granular or mottled soft tissue with gas in the stomach. In 73% (11/15) of dogs requiring surgery, history, clinical findings, and survey abdominal radiographs sufficed to proceed with celiotomy. Surgical removal of the Gorilla Glue foreign body was performed via gastrotomy (n = 14) or gastrotomy and duodenotomy (n = 1). Endoscopic removal was performed in one dog. One dog with suspected mechanical obstruction was euthanized owing to financial constraints. Remaining cases were managed conservatively (n = 5). Short-term prognosis following appropriate fluid therapy and surgical or endoscopic removal was very good.

Evaluation of scar revision after inadequate primary excision of cutaneous mast cell tumors in 85 dogs (2000-2013).

OBJECTIVE: To determine the frequency of residual tumor, and factors associated with local recurrence and disease progression in dogs with incompletely excised mast cell tumors (MCT) following scar revision surgery. STUDY DESIGN: Retrospective study. ANIMALS: Eighty-five dogs. METHODS: Medical records from January 2000 to April 2013 were reviewed. Dogs with scar revision surgery after incomplete primary MCT excision were included. Recorded were signalment; initial tumor size, location and grade; time interval between primary excision and scar revision surgery; presence of MCT in the resected scar; local recurrence, lymph node metastasis, systemic metastasis, and cause of death. RESULTS: Eighty six tumors in 85 dogs were studied. Residual MCT was found in 23 (27%) resected scars. Seven (8%) scars with residual MCT had incomplete or narrow margins. Follow-up was available for 68 dogs (69 tumors; median 403 days; range 4-2939). Local recurrence was reported in three (4%) dogs at 212, 555, and 993 days. Disease progressed in 10 dogs (14.5%) with regional or systemic metastasis at a median of 207 days (64-1583). Margin status and presence of MCT in the resected scar were not associated with local recurrence or disease progression. Lymph node metastasis (p = .004), locoregional recurrence (p = .013), and disease progression (p = .001) were significantly more likely in Grade III tumors. CONCLUSION: Twenty-seven percent of resected scars contained residual MCT, but recurrence was uncommon after surgical revision. CLINICAL SIGNIFICANCE: Clinicians should primarily consider tumor grade when estimating the likelihood of local recurrence and disease progression and determining the need for ancillary treatment of MCT after scar resection.

Factors influencing complications following mastectomy procedures in dogs with mammary gland tumors: 140 cases (2009-2015).

OBJECTIVE: To evaluate complication rates for various types of mastectomy procedures, identify factors associated with an increased risk of complications, and determine the consequences of such complications. ANIMALS: 140 female dogs that underwent 154 separate mastectomy procedures to treat mammary gland tumors. PROCEDURES: Medical records of dogs in the Penn Vet Shelter Canine Mammary Tumor Program from July 2009 to March 2015 were reviewed. Data regarding signalment, tumor characteristics (ie, number and size, benign or malignant, and bilateral or unilateral), mastectomy type, anesthesia time, concurrent ovariohysterectomy or ovariectomy, surgeons' qualifications, antimicrobial administration after surgery, postoperative placement of surgical drains, and complications (seroma, abscess, dehiscence, or infection) were collected. Complications that required hospitalization were recorded. Fisher exact tests were used to evaluate associations between variables of interest and complications. Multivariable analysis was used to identify factors independently associated with an increased risk of complications. RESULTS: Complication rate following all mastectomy procedures was 16.9% (26/154); of these, 9 (34.6%) required hospitalization. High body weight, undergoing bilateral mastectomy, and postoperative antimicrobial administration were associated with significantly increased odds of complications. The odds of complications associated with postoperative antimicrobial administration, however, varied according to mastectomy type; dogs undergoing chain mastectomy that did not receive antimicrobials postoperatively had the highest odds of developing complications. Dogs undergoing concurrent ovariohysterectomy or ovariectomy had significantly decreased odds of complications. CONCLUSIONS AND CLINICAL RELEVANCE: Previously spayed dogs with a large body size that underwent the most extensive mastectomy procedures had increased odds of having postoperative complications.

Simultaneous quantification of cyclosporin, tacrolimus, sirolimus and everolimus in whole blood by UHPLC-MS/MS for therapeutic drug monitoring.

The aim of this study was to develop and validate a UHPLC-MS/MS assay to quantify cyclosporin (CYC), tacrolimus (TAC), sirolimus (SIR) and everolimus (EVE) in human whole blood for therapeutic drug monitoring. Analytes were extracted from 50 µL human whole blood by protein precipitation. The separation of the drugs was performed on an Acquity UPLC BEH C18 column. Analytes were eluted with a mobile phase consisting of 2 mM ammonium acetate with 0.1% formic acid (v/v) in deionised water and 2 mM ammonium acetate with 0.1% formic acid (v/v) in methanol at a flow rate of 300 µL/min in gradient elution. The method performance was evaluated by analysing patient blood samples and/or external quality control samples [proficiency testing (PT) scheme]. The method was linear from 23.75 to 1094.0, 1.3 to 42.4, 1.3 to 47.0 and 1.2-41.6 µg/mL for CYC, TAC, SIR and EVE, respectively. The within- and between-assay reproducibility results were ˂ 11%. Results from PT and patient sample quantification were comparable to those obtained previously by an in-house validated method using protein precipitation and liquid-liquid extraction. This method showed good analytical performance for quantifying CYC, TAC, SIR and EVE in whole blood over their respective calibration ranges.

Alternative Input for Perfusion Management Devices: Voice Recognition for Data Input and the Effects on Charting and Perioperative Calculation Use.

Technology in healthcare has become increasingly prevalent and user friendly. In the last decade, advances in hands-free methods of data input have become more viable in a variety of medical professions. The aim of this study was to assess the advantages or disadvantages of hands-free charting through a voice-to-text app designed for perfusionists. Twelve clinical perfusion students using two different simulated bypass cases were recorded and assessed for the number of events noticed and charted, as well as the speed at which they accomplished these steps. Paper charts were compared with a custom app with voice-to-text charting capability. Data was analyzed using linear mixed models to detect differences in length of time until a chartable event was noticed, and how long after noticing an event it took to record the event. Timeliness of recording an event was made by assessing log-transformed time data. There was significantly more information recorded when charting on paper, while charting with voice-to-text resulted in significantly faster mean time from noticing an event to the recording of it. There was no significant difference between how many events were noticed and recorded. When using paper charting, a higher percentage of events that were missed were drug administration events, while voice charting had a higher percentage of missed events that were associated with cardioplegia delivery or bypass timing. With a decreased time interval between noticing an event and charting the event, speech-to-text for perfusion could be of benefit in situations where many events occur at once, such as emergency situations or highly active portions of bypass such as initiation and termination. While efforts were made to make the app as intuitive as possible, there is room for improvement.

Discussion: can upper extremity (deltoid) near infrared spectroscopy be used to assess cerebral tissue bed saturation on femorally cannulated veno-arterial extracorporeal membrane oxygenation patients?

Continuous cerebral tissue saturation monitoring with near infrared spectroscopy may help clinicians identify cerebral desaturation early; however, patients have reported discomfort from near infrared spectroscopy monitoring pads on the forehead. This study aims to compare upper extremity near infrared spectroscopy monitoring to cerebral near infrared spectroscopy monitoring to assess its viability as a surrogate for cerebral saturation. A retrospective analysis of 10 femorally cannulated veno-arterial extracorporeal membrane oxygenation patients was performed comparing left (L) and right (R) upper extremity (deltoid) near infrared spectroscopy monitoring to cerebral near infrared spectroscopy monitoring (n = 20 data sets, 10 left and 10 right) and right radial blood gasses. Deltoid and cerebral near infrared spectroscopy values were recorded every 15 minutes for at least 24 hours when possible, were plotted on scatter grams, and were analyzed using Pearson product-moment coefficient (r). Based on the concept of covariance, a moderate-good relationship r = 0.50-0.75 was noted in 10% (n = 2) of the study group. A fair relationship r = 0.25-0.50 was noted in 50% (n = 10), and little or no relationship was noted in 40% (n = 8). None of the study group displayed a good to excellent relationship (r = 0.75 or above). In addition, coefficient of multiple determination for multiple regression R2 was calculated and strong fit of the regression line was not noted. Although cerebral near infrared spectroscopy monitoring has been extremely helpful in identifying low cerebral tissue saturation on veno-arterial extracorporeal membrane oxygenation patients, the use of upper extremity (peripheral deltoid) tissue monitoring does not provide adequate correlation and should not be used as a surrogate to cerebral monitoring.

Quantification of mycophenolic acid in human plasma by liquid chromatography with time-of-flight mass spectrometry for therapeutic drug monitoring.

This study presents, for the first time, the development and validation of a liquid chromatography and time-of-flight mass-spectrometry (LC-TOF-MS) based assay to quantify mycophenolic acid (MPA) in patient samples as part of a routine therapeutic drug monitoring service. MPA was extracted from 50 µl human plasma by protein precipitation, using sulindac as internal standard (IS). Separation was obtained on a Luna™ Omega polar C18 column kept at 40°C. The mobile phase consisted of a mixture of acetonitrile-deionized water (50:50, v/v) with 0.1% formic acid at a flow rate of 350 µl/min. Analyte and IS were monitored on a TOF-MS using a Jet-Stream™ (electrospray) interface running in positive mode. Assay performance was evaluated by analysing patient plasma (N = 69) and external quality assessment (N = 6) samples. The retention times were 2.66 and 2.18 min for MPA and IS, respectively. The lower limit of quantification of MPA was 0.1 µg/ml. The within- and between-assay reproducibility results ranged from 1.81 to 10.72%. Patient and external quality assessment sample results were comparable with those obtained previously by an in-house validated LC-MS/MS method. This method showed satisfactory analytical performance for the determination of MPA in plasma over the calibration range of 0.1-15.0 µg/ml.

Effect of perioperative desmopressin in cats with mammary carcinoma treated with bilateral mastectomy.

Perioperative administration of desmopressin has shown to significantly decrease rates of local recurrence and metastasis, and increase survival times in dogs with grade II and III mammary carcinomas. The objective of this study was to compare the oncologic outcome of cats with mammary carcinoma treated with bilateral mastectomy with or without perioperative administration of desmopressin. Medical records from nine veterinary institutions were searched to identify cats diagnosed with mammary carcinoma treated with bilateral mastectomy. Sixty cats treated with single-session or staged bilateral mastectomy were included. There were no significant differences in oncologic outcomes found between cats treated and not treated with desmopressin. No adverse effects were seen in any of the cats treated with perioperative desmopressin. Postoperative complications occurred in 18 cats (38.3%) treated with single-session bilateral mastectomy and in three cats (23.1%) treated with staged bilateral mastectomy (P = .48). Histologic grade and a modification of a proposed five-stage histologic staging system were both prognostic for disease-free interval. Incomplete histologic excision was associated with significantly increased rates of metastasis and tumour progression, and a shorter median survival time (MST). Cats that developed local recurrence also had a significantly shorter MST. The results of this study do not support the use of perioperative desmopressin to improve outcome when performing bilateral mastectomy for the treatment of mammary carcinoma in cats.

Implementation of a Prescriptive Extracorporeal Circuit and Its Effect on Hemodilution and Blood Product Usage during Cardiac Surgery.

The use of cardiopulmonary bypass (CPB) contributes significantly to intraoperative anemia. The use of a prescriptive circuit that is tailored to the patient size could significantly reduce priming volumes, resulting in less hemodilution. The purpose of this study was to determine whether a prescriptive circuit resulted in decreased hemodilution, reduced blood product usage, and improved outcomes. In total, 204 patients prospectively received the prescriptive protocol between March 2019 and November 2019. This protocol was composed of three circuit sizes: small [body surface area (BSA) ≤ 1.85 m2], medium (BSA 1.86-2.30 m2), and large (BSA ≥ 2.31 m2). Data for CPB and post-bypass transfusions were collected, along with postoperative outcomes. These patients were then 1:2 propensity score matched to 401 patients who were retrospectively reviewed who had undergone cardiac surgery using a one-sized CPB circuit. The prescriptive protocol cohort had more patients with renal disease, whereas the conventional cohort had more history of hypertension. Intraoperative results show the prescriptive circuit had lower mean prime volume and total prime volume after reverse autologous prime (1,084 mL vs. 1,798 mL, p < .0001; 725 mL vs. 1,181 mL, p < .0001). Ultrafiltration was higher in the prescriptive group (872 vs. 645 mL, p < .0001), which likely balanced the increased use of del Nido cardioplegia in the prescriptive group (1,295 vs. 377 mL, p < .0001). The drop in hematocrit (HCT) from baseline was less in the prescriptive group (15.1 ± 4.91 vs. 16.2 ± 4.88, p = .0149), whereas the postoperative HCT was higher (32.79 ± 4.88 vs. 31.68 ± 4.99, p = .0069). Transfusion of packed red cells did not change between the two groups. Implementation of a prescriptive circuit did not reduce on-bypass or intraoperative blood product usage. However, there was a significant reduction in on-bypass hemodilution and increased postoperative HCT.

Perfusion Recruitment Strategies Using Choice-Based Conjoint Analysis.

Perfusionists are leaving the workforce in higher rates as baby-boomers retire, yet the volume of cases involving perfusion continues to increase. This change has resulted in a high-demand market with organizations competing for the same candidates. The purpose of this study was to use a choice-based conjoint (CBC) analysis to determine what attributes of employment opportunities are most important to perfusionists so hiring organizations are better equipped to produce employment offers specific to each candidate. The Sawtooth Software Discover program was used to create a CBC survey that was distributed to perfusionists. After a series of demographic questions, respondents chose between three employment offers that comprised eight attributes, each with three varying options. Completed surveys were analyzed using the Discover software, producing importance scores. Two hundred forty surveys were completed, 154 (64%) male and 86 (36%) female. Extracorporeal membrane oxygenation (ECMO) impact to the perfusionist and hours worked per week ranked most important, at 19.4% and 17.5%, respectively. A significant difference exists between ECMO impact to perfusionists and all other attributes. The least important attributes were annual continuing education funds and sign-on bonus/relocation, at 6.8% and 4.7%, respectively. Respondents in their 20s and 30s find the importance of ECMO impact to be significantly less important than those in their 50s. Perfusionists with a master's degree believe salary to be significantly more important than perfusionists with other types of perfusion education. Based on the respondents who completed this survey, the impact ECMO has on the perfusionist was the most significant job attribute. Offering large sign-on bonuses and relocation packages to entice new employees is not indicated as a viable way to satisfy perfusionists. Appropriate management of hours worked, days on call, and how ECMO impacts the perfusionists will be most impactful in recruitment of new employees.

Microorganisms associated with incisional infections after gastrointestinal surgery in dogs and cats.

OBJECTIVE: To determine the rate of incisional infections after gastrointestinal surgery in dogs and cats and describe the aerobic bacteria isolated from these infections. STUDY DESIGN: Retrospective study. ANIMALS: Client-owned dogs (n = 210) and cats (n = 66). METHODS: Records of dogs and cats that underwent gastrointestinal surgery at the Matthew J. Ryan Veterinary Hospital at the University of Pennsylvania were reviewed for surgical procedures, presence of an infection, bacterial species isolated, perioperative antimicrobials administered, and outcome. RESULTS: The median duration of follow-up was 14 days (4-35). Incisional infections were recorded in 7% (20/276) of cases. Among those 20 cases, culture results were available in 12 of 20 cases. The most common bacterial isolate cultured was Escherichia coli. The most common perioperative antimicrobials administered to treat incisional infection were cefazolin and cefoxitin. Only two of the bacterial isolates were susceptible to these antimicrobials. Bacteria isolated from incisional infections were most often susceptible to chloramphenicol, imipenem, and gentamicin. CONCLUSION: Bacterial isolates from incisional infections in this population consisted of native gastrointestinal flora, which was often resistant to the most commonly used perioperative antimicrobials. CLINICAL SIGNIFICANCE: Contamination at time of surgery is the most likely source of incisional infection after gastrointestinal surgery. This rate of infection justifies more rigorous intraoperative hygiene protocols and evaluation of the antimicrobials' susceptibility of causative bacteria to guide antimicrobial treatment.

Intraoperative near-infrared imaging can identify canine mammary tumors, a spontaneously occurring, large animal model of human breast cancer.

INTRODUCTION: Current methods of intraoperative margin assessment in breast conserving surgery are impractical, unreliable, or time consuming. We hypothesized that intraoperative near-infrared (NIR) imaging with an FDA-approved NIR optical contrast agent could identify canine mammary tumors, a spontaneous large animal model of human breast cancer, during surgery. METHODS: Dogs with mammary tumors underwent a standard of care lumpectomy or mastectomy with wide surgical margins 20 hours after indocyanine green administration (3 mg/kg IV). During surgery, NIR imaging was performed on tumors and wound margins in situ and tumors and lymph nodes ex vivo. Following resection, the wound bed was examined for residual fluorescence. Fluorescence intensity was determined by signal-to-background ratio (SBR). All tumors, areas of residual fluorescence, and lymph nodes underwent histopathologic analysis. RESULTS: There were 41 mammary tumors in 16 female dogs. Twenty tumors were malignant and 21 were benign. Twenty-eight tumors were fluorescent (mean SBR 1.5±0.2). Sensitivity of fluorescence for all malignant tumors was 80% (16/20) and 93.3% (14/15) for malignant tumors > 2 cm. Specificity for malignancy was low (< 2cm = 55%; > 2cm = 30%). Tumors > 2 cm were more likely to be fluorescent (OR 6.05, 95% CI 1.50-24.44, P = 0.011) but not more likely to be malignant (OR 3.09, 95% CI 0.86-11.14, P = 0.085) than tumors ≤ 2 cm. Four out of seven inguinal lymph nodes excised in the mastectomy specimen fluoresced. All four drained malignant tumors; however only 2/4 contained metastatic disease. CONCLUSION: Systemic ICG accumulates reliably in malignant canine mammary tumors > 2 cm. Although no tumor margins fluoresced, a wider margin of normal tissue is removed in canine mastectomy, making direct comparisons with breast conserving surgery difficult. Targeted NIR imaging agents are likely required to improve detection of smaller tumors and improve the specificity of NIR imaging for residual disease and metastatic lymph node detection.

Evaluation of Jackson-Pratt Thoracostomy Drains Compared with Traditional Trocar Type and Guidewire-Inserted Thoracostomy Drains.

A restrospective study was performed to evaluate the efficacy of and complications among Jackson-Pratt (JP) drains placed as thoracostomy drains, traditional trocar type (TRO) thoracostomy drains, and guidewire (GW)-inserted thoracostomy drains that were placed in open fashion during thoracotomy. Medical records of 65 canine and feline patients who underwent thoracic surgery were evaluated. Dogs and cats who underwent thoracotomy and had a chest drain placed intraoperatively were included. Data retrieved from medical records included signalment, body weight, diagnosis, surgical approach, surgical procedure, type of thoracostomy drain, postoperative analgesia, duration of thoracostomy drain, and postoperative complications. The incidence of complications and number of medications used in pain protocols were compared among types of thoracostomy drains. JP (n = 31), TRO (n = 25), and GW (n = 9) thoracostomy drains were placed in 65 patients. Ten minor (15.3%) and four major (6.2%) complications occurred. Cases with JP thoracostomy drains were significantly less likely to have complications (2 minor, 1 major) than cases with TRO thoracostomy drains (8 minor, 3 major, P = .009). There were no differences in the number of major complications when comparing all three drains individually (P = .350). JP drains and GW drains can be considered as an alternative to traditional TRO thoracostomy drains.

Near-infrared imaging and optical coherence tomography for intraoperative visualization of tumors.

Surgical excision is the foundation of treatment for early-stage solid tumors in man and companion animals. Complete excision with appropriate margins of surrounding tumor-free tissue is crucial to survival. Intraoperative imaging allows real-time visualization of tumors, assessment of surgical margins, and, potentially, lymph nodes and satellite metastatic lesions, allowing surgeons to perform complete tumor resections while sparing surrounding vital anatomic structures. This Review will focus on the use of near-infrared imaging and optical coherence tomography for intraoperative tumor visualization.